Building Effective State Advocacy Programs

©2021 MGMA. All rights reserved.

Building Effective State Advocacy

Programs

Claire Ernst, JD

Director

Matt Devino, MPH

Associate Director

MGMA GOVERNMENT AFFAIRS

WASHINGTON, DC

©2021 MGMA. All rights reserved. - 2 -

1. Discuss how to successfully engage state MGMA

members and other stakeholder groups in

advocacy at the state level

2. Identify state advocacy challenges, lessons

learned, and best practices

3. Describe the elements needed to build successful

advocacy programs

Learning Objectives


1. Welcome

2. How Washington Works

3. Advocacy 101

4. Best Practices

5. Open Discussion & Questions

Agenda


Welcome to MGMA Advocacy!

Meet the Team

Kelsey Haag, MPH

Associate Director

Anders Gilberg, MA

Senior Vice

President

Claire Ernst, JD

Director Matt Devino, MPH

Associate Director Emily Dowsett

Associate Director,

Public Affairs

Together with State Legislative Liaisons, MGMA advocates on issues affecting

medical groups at the state and national levels.


Add the MPE: Leaders Conference mobile app to

your device and ask your questions in the chat

Visit mgma.com/mobileapp for more details or

scan the QR code

Ask Your Questions

https://mgma.com/mobileapp


How Washington Works


Separation of Powers in the Federal Government

The Three Branches

1. Congress (legislative):

• The House and Senate introduce, debate, amend and vote on legislation

• Legislation that passes both chambers with a majority vote go to the executive for

consideration

2. President and the Departments/Agencies (executive):

• Approves or vetoes legislation from Congress

• Creates regulatory rules when necessary

3. Supreme Court (judicial):

• “Checks” the actions of Congress and the Executive when necessary


Congress


How A Bill is Supposed to Become Law…


How a Bill Really Becomes a Law…


In Congress, What are the Odds?

Is there an upcoming deadline?

Is there a catalytic event?

Did Congress recently

pass a bill in that policy area?

Who controls the

White House?

Is there an election

coming up?

What is the perceived impact of

the legislation?

What will stakeholder

s have to say?

Is the media

pushing it in some

way?

Is it bipartisan?


“Washington Speak”: Decoded

Short-term legislation that continues current funding when the gov. fails to agree on budget.

Continuing resolution

Bills that include diverse, unrelated topics.Omnibus package

Special rules allowing budget-related bills to pass with a simple majority.

Reconciliation

“Must-pass” legislation onto which less popular provisions are added.

Legislative vehicle

Series of amendments votes often used as political tactic to slow down passage of a budget bill.

Vote-a-rama

Differences between House-passed and Senate-passed version of the same legislation are worked out.

Conference


Congressional Committees

• Congressional committees provide the most intensive consideration of a

proposed measure as well as the forum where the public is given their

opportunity to be heard.

• Each committee’s jurisdiction is divided into certain subject matters and

all measures affecting that area of law are referred to the committee with

jurisdiction.

• Committees with jurisdiction over healthcare issues, including Medicare:

• House Ways & Means Committee

• House Energy & Commerce Committee

• Senate Finance Committee

• Senate HELP Committee

• Membership on the various committees is divided between the two major

political parties.

• Appointments are determined by each party by expertise and seniority.


The Administration


How Rulemaking Works

Regulations come from the 15 federal executive department and agencies, and sub-agencies, including the Department of Health and Human Services (HHS).

Within HHS:


Why Is Rulemaking Important?

The law is only the framework

Federal agencies have substantial discretion.

Regulations have the force of law.

Often overlooked by media.

Many reasons why an agency will make a rule:

o Congressional mandate,

o Agency identifies a problem,

o Petition for rulemaking from regulated groups, or from advisory committees or oversight groups within government.


How Rulemaking is Supposed to Work

Resource: federal government guide to the rulemaking process

A simplified example of the rulemaking process:

Law is passed

requiring rulemaking

Department issues a

proposed rule

Public Comment

Period

Department reviews

comments, makes

modifications

Department issues final

rule

https://www.federalregister.gov/uploads/2011/01/the_rulemaking_process.pdf


How Rulemaking Really Works…


Why Does it Work this Way?

Defining the problem is a challenge

Bound by statuteTimeframes often dictated

by congress

Limited budgets, staff, and technology

Agencies are impacted by

• Organizational structure

• Division of labor

• Culture

• Motives and expertise of individual agency staff

Power grab of another agency


Advocacy 101


Advocacy 101: Effectively Lobbying Your Lawmakers

Additional resources are available on the MGMA website:

Write Your Legislator ● State Legislative Liaison Resources

Legislative and regulatory advocacy are efforts to influence the introduction, enactment or

modification of legislation and proposed rulemaking.

https://www.mgma.com/advocacy/make-change-happen/take-action

https://www.mgma.com/about/state-affiliates/legislative-liaison


How Can I Influence Decisions?

Successful advocacy is all about relationships and respect

Develop clear “asks”

• Administration

• Congress

• State officials

Know the correct contacts for the issues you’re trying to influence

Recognize the tools at your disposal

Leverage the power of coalitions


What is an “Ask”?

• Simple/unified message of what lawmakers should do to address issue.

• For example - MGMA’s ask for fair Medicare reimbursement is:

• “Pass legislation that would provide updates to the Medicare physician

payment system that cover the cost of delivering medical services to Medicare

beneficiaries.”

• Put a face to the issue

• Use real world stories to show how the issue affects your practice.

• Give a narrative and use numbers/data to back the narrative up.


Knowing the Correct Audience: Federal vs. State Issues

MIPS

Alternative Payment Models

Accountable Care

Organizations

Medicare Physician Fee

Schedule

Audits and Appeals –

Recovery Audit Contractors

(RACs)

Medicare Administrative

Contractors (MACs)

Physician Self-referral (Stark)

Rules

HIPAA Privacy Rules and

Procedures

Healthcare Transactions and

Administrative Simplification

ONC Health IT

ICD-10

Physician Open Payments

Veterans Choice Program

Insurance Commissioners

and Commercial Insurance

Regulations

Medicaid and CHIP

Clinician and Facility

Licensing

Prescription Drug Monitoring

Programs

Telehealth Licensure

Requirements

Federal State


Be Involved: Contacting Congress

Who do I contact?

- For major legislative issues, contact the Washington, DC, office of your federal representatives.

- Each office usually has a health legislative aide (health LA) who focuses on health-related issues.

These staff are likely the target of your advocacy outreach.

- Please feel free to contact the MGMA Government Affairs Department for this information.

- Address all correspondence to the Member of Congress.

How do I contact them?

- Visit mgma.com to find contact information

- MGMA routinely posts grassroots updates with sample letters and updates sent via the

Washington Connection

- Send letters, make phone calls, schedule in-person meetings


MGMA.com/CONTACTCONGRESS

- 26 -

Contact Congress

https://www.mgma.com/advocacy/make-change-happen/contact-congress#/


Be Involved: Influencing the Administration

Submit your own comments at regulations.gov

- Keep letters focused on the proposed rule

- Give feedback on areas that are under an agency’s discretion, not details dictated by statute

- Explain the real-world repercussions of proposals

Provide feedback to MGMA


How does your state approach advocacy?

• Partnerships and coalitions

• Grassroots

• Stakeholder involvement

• Issue tracking and membership education

• Communication with state legislatures

• Advocacy events (i.e., “Capitol Day” or site visits)

• Other?


Best Practices


Best Practices

✔ Track state health legislation and regulations that could impact state MGMA members, and keep

state members apprised of these items.

- How?

• via participation in state medical society/association calls and updates;

• signing up for listservs;

• using a state legislation tracking software system

✔ Emphasize the importance of legislative issues within your state MGMA board and provide

updates on legislative and regulatory matters at state board meetings.

- How?

• have a monthly legislative update incorporated into board meetings;

• have a monthly call to share key legislative and regulatory updates;

• create a legislative committee at the state level


Best Practices

✔ Keep members informed and engaged with advocacy efforts.

- How?

• Forward the Washington Connection

• Provide information on programs/events that can involve/educate members on a particular issue

• Engage in letter writing campaigns, meetings with legislators

✔ Foster communication among state members who are implementing state and federal

requirements in their practices. Facilitate discussions and strategies for how to best approach

challenges.

✔ Create a strategic advocacy plan for your state MGMA.

- If you’ve never done this, reach out to your peers for examples

https://www.mgma.com/advocacy/washington-connection


Best Practices

✔ Reach out to key state legislators focused on healthcare policy.

- How?

• Schedule a meeting with the lawmaker at their office

• Schedule a site visit

• Write letters

✔Attend developmental conferences.

- Including MGMA national, state medical society events

✔ Leverage your relationship with national MGMA.

- We are here to answer your questions on issues in Medicare, HHS, and other agencies.

-


Calls and Meetings with CMS/HHS staff

Discussions

with Congress

Advocacy

statements

and letters

Washington Connection newsletter

Member-benefit

resources

Dedicated

Member

Communities

Washington Update

presentations

Access to GA

experts

Collaboration

with state

MGMAs

Government Affairs

Council (GAC)

Coalition and

consensus

building with

industry partners

Grassroots

advocacy

MGMA Government AffairsADVOCACY “FEEDBACK LOOP”

MGMA Healthcare

Guiding Principles

MGMA Membership Federal

Advocacy

- 33 -


Remember: Advocacy Matters!

• Lawmakers make decisions that affect you, your patients,

and your practice.

• Voicing your concerns to government is one of the most

important steps to influencing the decisions that affect

your practice.

• Advocacy works!

If you’re not at

the table, you’re

on the menu


Open Discussion & Questions


Thank You!

@ClaireErnstJD

Claire Ernst, JD

Director


WASHINGTON, DC

[email protected] | 202.293.3450

Matt Devino, MPH

Associate Director


WASHINGTON, DC

[email protected] | 202.293.3450

@matt_devino

Building Effective State Advocacy Programs

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